1 The RN BSN Distance Education Experience: From Educational Limbo to More Than an Elusive Degree KATHY L. RUSH, PHD, RN,* SUSANNAH WALDROP, MS,y CAROL MITCHELL, MSN, RN,z AND CATHY DYCHES, PHD, RN This study describes a qualitative study designed to gain an understanding of professional growth as experienced by RN BSN students taking their program by distance delivery. A convenience sample of senior students enrolled in an RN BSN program, taking their classes either by live televised broadcast or by online instruction, volunteered to participate in the study. Data were collected through the use of online student discussions that took place over a 2-week period. The discussion was guided by the use of a semistructured interview schedule and facilitated by one member of the research team. Interview questions were posted every 2 to 3 days; additional questions were posted as threads as discussion board comments warranted. RN BSN students described their pursuit of a BSN as a journey of being and becoming a professional. Although students already felt professional, the impetus for the journey could be traced to the overriding theme of falling short as a professional. RN BSN students described their beginning journey toward the baccalaureate degree as an educational limbo, out of which they moved with discovery of the RN BSN distance program. What began as pursuit of an elusive degree that was expected to produce minimal change became more as RN BSN students evolved as professionals along many dimensions. The implications of these findings for the development and design of curricular and pedagogical approaches to better serve the needs of this unique group of learners will be addressed. (Index words: Professional growth; RN BSN students; Distance *Professor, Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg, SC. ycoordinator, RN BSN Program, Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg, SC. zassociate Professor, Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg, SC. Associate Professor, Mary Black School of Nursing, University of South Carolina Upstate, Greenville, SC. Address correspondence and reprint requests to Dr. Rush: Mary Black School of Nursing, University of South Carolina Upstate, 800 University Way, Spartanburg, SC /$ - see front matter n 2005 Elsevier Inc. All rights reserved. doi: /j.profnurs education) J Prof Nurs 21: , A 2005 Elsevier Inc. All rights reserved. THE NEEDS OF an increasingly complex and demanding health care system have prompted calls for educational preparation of the nursing workforce at or higher than the baccalaureate level. However, less than one third of the nursing workforce is BSN prepared. At the same time, enrollments in nursing education programs are declining, particularly in RN-to-BSN programs, with only 16% of associate degree nurses (ADNs) moving on to obtain a BSN degree (American Association of Colleges of Nursing [AACN], 2000). Encouraging ADNs to continue their education has been recommended as one way to meet changing health care demands (AACN, 2000). In reworking RNs professional identity, MacIntosh (2003) found that RNs returned to school as a way to move on and protect themselves, stay stimulated, and avoid stagnation. These motivations are consistent with the intent of baccalaureate education to cultivate a student s professional socialization and development. However, it has been well documented that ADNs returning to school are at a higher level of professionalization than generic students at program entry (Fetzer, 2003). Use of the inductive approach to professionalism gained during baccalaureate education has been challenged for returning ADNs (Fetzer, 2003). The extent to which baccalaureate education promotes professional development for ADNs returning to school has not been well studied. Enhancing professional development has been identified as an important factor in students decision to join distance education courses (Tricker, Rangecroft, & Long, 2001). Concerns regarding the professional socialization of RN BSN students taking their degrees at a distance have been raised in the literature. No study that specifically explored perceptions of professional development among RN BSN students taking their nursing program by distance Journal of Professional Nursing, Vol 21, No 5 (September October), 2005: pp
2 284 delivery could be found. Gaining an understanding of distance RN BSN students perceptions of their professional development is important to better meet their expectations and to enhance the quality of their learning experience (Rangecroft, Gilroy, Long, & Tricker, 1999). Furthermore, it has important implications for curriculum development and the designing of pedagogical approaches that will better serve the needs of this unique group of learners. Therefore, the purpose of this exploratory study was to gain an understanding of the perceptions of professional development among RN BSN students taking their program by distance delivery. Review of the Literature PROFESSIONAL GROWTH OR PROFESSIONALIZATION RNs returning to school (RN BSN) enter their baccalaureate education program at a level of professionalization different from that of basic students having internalized professional attitudes, values, beliefs, and identities as a result of prior education and work experience (Fetzer, 2003). Although RN BSN students tend to value their basic nursing program and view their baccalaureate education merely as a stepping stone to other opportunities, research has shown that they do undergo a process of change during their postbasic education (Zuzelo, 2001). Resocialization or, alternatively, perspective transformation has been shown to occur when RNs return for degrees (Eckhardt, 2002). As they learn new roles, RN BSN students are able to perform at a more professional level (Eckhardt, 2002). Professional change and growth is a theme that emerged from qualitative studies on RN BSN students who were registered in or had recently graduated from on-site postbasic nursing education programs (Harrington, 1995; Lillibridge & Fox, 2005; Zuzelo, 2001). The qualitative study of Harrington (1995) on 18 recently graduated female RN BSN students revealed that they had experienced professional change to varying degrees in three areas: (1) as a member of the profession, (2) professional identity, and (3) as a provider of care. The theme of professional growth was reported in a more recent study on the concerns and priorities of part-time female RN BSN students studying on-site. Areas of professional growth included greater use of research in practice; a broader, holistic knowledge base and professional perspective; questioning practice; development as more effective leaders; and perception of nursing as a career (Zuzelo, 2001). Lillibridge and Fox (2005) similarly found that RN BSN students doing their baccalaureate program on campus part time looked at things differently, gained a more global perspective, experienced feelings of personal accomplishment, and grew in knowledge. Armstrong, Gessner, and Kane (1999) found professional growth evident in the professional reading done by RN BSN students during and 6 months following their program as compared with their ADN colleagues. RN BSN students read significantly more nursing research literature because of interest, application, and commitment. DISTANCE EDUCATION RUSH ET AL Program design has been shown to influence the professional socialization of RN BSN students (Eckhardt, 2002). Van Maanen and Schein (1979) developed a theory of organizational socialization that conceptualizes people s responses to different forms of socialization along a bureaucratic professional continuum. With the use of this theory, Eckhardt (2002) found that program design influenced RN BSN students professional role conceptions. The highest level of professionalism on the continuum, role innovation, was found in programs oriented to the individual, valued work-related experience and previous knowledge, provided more flexibility in terms of experiences and timelines, and had frequently changing faculty who offered few peer role models. Distance education programs provide a unique design for ADNs returning to school. Concern regarding the negative impact of distance education on professional development has been raised in the literature (Reinert & Fryback, 1997). Faculty from schools of nursing offering distance programs identified socialization of students to the professional role as an important issue regardless of their educational level (Reinert & Fryback, 1997). Factors such as lack of immersion in the academic milieu and interaction with faculty and fellow students have been identified as hindrances to professional development for distance education nursing students (Cragg, Plotnikoff, Hugo, & Casey, 2001). Quantitative research has shown that RN BSN students taking their baccalaureate education through distance delivery achieve better professional socialization outcomes than senior BSN students enrolled in either campus-based or distance programs (Nesler, Hanner, Melburg, & McGowan, 2001). Cragg et al. (2001) found that RN BSN students taking their
3 THE RN BSN DISTANCE EDUCATION EXPERIENCE 285 program exclusively by audioteleconference scored higher on perspective transformation than RN BSN students taking their program on-site or as a combination of distance and on-site delivery. Furthermore, connection with same-site students was found to increase perceived professional identity for nursing students in a distance master s nursing program (Lia-Hoagberg, Vellenga, Miller, & Li, 1999). In summary, quantitative and qualitative research corroborate the finding that on-campus RN BSN education programs promote the professional growth of returning ADN students who enter at a higher level of professionalization than their basic baccalaureate counterparts. Program design has been shown to influence RN BSN students professional role conceptions. Although distance educational designs have been thought to negatively impact professional development, such has not been empirically supported. Research addressing the perceptions of professional development among RN BSN students taking their nursing program by distance delivery is lacking. Methodology DESIGN A qualitative descriptive design was used to elicit the perceptions of RN BSN students taking their education program by distance delivery. The use of such a design allowed for more in-depth discussion of the perspectives of postbasic students as to their professional development. SAMPLE Senior students enrolled in an RN BSN program in the southeastern United States were approached and invited to participate in the study. Students in the program, who were scattered throughout the state, could choose to take classes either by live televised broadcast (ETV) or by online instruction. The 36 students who agreed to participate in the study were assigned to one of three online discussion groups: 24 to one of the two ETV groups and 12 to one web group. All distance students at the University of South Carolina Upstate have an online component to their courses and are accustomed to this medium. A description of the sample appears in Table 1. DATA COLLECTION Following university institutional review board approval, we introduced the RN BSN students to the study during a regularly scheduled ETV class or TABLE 1. Interview Questions 1. Think back to the time preceding your return to school. Describe yourself as a professional at that time. 2. What has it been like to take your RN BSN by distance delivery? What do you tell others about your internet (or ETV) educational experience? How has being a distance education student changed you? 3. Since returning to school, what changes have you observed in yourself? (Prompts: If positive, talk about factors they perceive as contributing to this change; if negative, talk about negating factors.) 4. How would a co-worker describe changes (if any) in you since beginning the RN BSN program? 5. What changes would you like to see in yourself by graduation? Do you think if you had chosen a non-distance program that you would feel differently about your educational experience? by way of an announcement posted online. An informed consent form explaining the nature of the study, students rights and responsibilities, and risks and benefits was posted online for all students to access. Copies of the informed consent form as well as a background personal information sheet were sent by regular mail to students. Students were asked to sign the forms and return them in a stamped selfaddressed envelop if they agreed to participate. Students were asked to participate actively in online discussions, posted on Blackboardk, which took place over a 2-week period. To assist students in preparing for the discussion and to avoid Groupthink, or the undue influence by the group, students received questions for reflection prior to the discussion (Carey, 1995). Students were given guidelines for their participation (e.g., using paragraph-length responses in a conversational style). Students were asked to respond regularly to the general discussion and to questions directed specifically to them. A semistructured interview schedule was used to facilitate the discussion with questions posted one at a time as new discussion threads every 2 to 3 days. The research team met every 3 to 4 days to review the discussion board postings and determine the need for additional threads based on the participants comments. The ongoing discussion was facilitated by a non-faculty member of the research team who requested clarification or more in-depth elaboration of student responses and generally directed the discussion to elicit a complete understanding of students perceptions of their professional growth. Interview questions appear in Table 2. DATA ANALYSIS Online discussions were printed as hard copies for purposes of analysis. Printed Blackboardk discussions
4 286 RUSH ET AL TABLE 2. Description of Sample Frequency Percentage (%) Age in years (M F SD) F 8.77 Years of experience F 8.95 (M F SD) Sex Male 2 6 Female Ethnic background Caucasian African American 5 14 Status Full time Part time 8 22 Education Diploma 3 8 ADN LPN AND year degree 1 3 (other than nursing) Distance education experience None courses courses 7 19 N4 courses 6 16 Places of employment General patient care 9 25 Critical care 9 25 Director/Manager 5 14 Public health 2 5 Community health 1 3 Ambulatory 3 8 Rehabilitation 2 5 Education 2 5 Supervisor 4 11 Pediatric services 1 3 were analyzed using the constant comparative method, as described by Lincoln and Guba (1985) and adapted by Maykut and Morehouse (1994). This method combines inductive coding with simultaneous comparison of all units of meaning. Initially, the data were coded independently by the three participating faculty members, who then met over time to cluster similar units of meaning into categories and subcategories as the data warranted. Researchers continually refined the categories to account for all units of meaning and discussed any differences in categorization of the data to arrive at consensus. Subsequently, relationships among major categories and subcategories were identified and reflected as more abstract themes. In addition to working with others in data analysis, trustworthiness of the data was safeguarded by maintaining an audit trail, and checking out with selected participants to ensure that the data interpretation reflected what was true for them. Findings RN BSN students described their pursuit of a BSN as a journey of being and becoming a professional. The journey was described according to five themes that included the following: (1) the impetus; (2) beginning bin limboq; (3) discovery of the RN BSN distance program as a turning point; (4) unexpectedly finding more than just a degree; and (5) sharing and making it known. THE JOURNEY RN BSN students perceived obtaining a BSN to be a continuing part of their professional journey. One student described it as a bbuilding block to my collective experience and education.q The degree was perceived as a goal and was, for most of the students, upheld for some time as noted in this student comment: bit has taken me several years to return to school but the desire and the need has been there since the day I finished the ADN program.q The journey toward the degree had been pursued by most students for many years and by many different routes. One student described their shared journey: We are all singing out of the same book but are on different pages. We all have a common goal and have gone down many different paths to get to where we are now. Impetus for the Journey: Falling Short as a Professional Students described themselves as professionals already, a self-identity that ranged from acknowledging that ball nurses that graduated from nursing programs are professionalsq to specific behaviors and conduct. One ETV student captures the range of professionalism: bi feel that before starting this program and even to this day I am professional. My conduct at work, my attire at work, my behavior, attitude and knowledge represent my professionalism.q Although students already felt bprofessional,q the impetus for the educational journey could be traced to the overriding theme of bfalling short as a professional.q Students described this falling short as professional rut or void, lack of preparation for an uncertain future, lack of career mobility, and lack of credibility. Experiencing a professional rut or void was an impetus for students to pursue a BSN. Students
5 THE RN BSN DISTANCE EDUCATION EXPERIENCE 287 described this professional void as bsomething lacking,q ban emptinessq in my career, ba lack of growthq despite an expanding knowledge base, knowledge that bthere has to be more to my career,q and dissatisfaction. Students also expressed the lack of career mobility and a BSN as a way to advance their careers. Other students wanted to obtain a BSN to be prepared for an uncertain future, as one student notes: Right now, there has not been a big difference [between ADN and BSN] noted in our hospital but I know it will eventually happen and I want to be prepared for it. The need for a BSN was also prompted by feeling a lack of credibility. It was expressed by students as a sense of inferiority, feeling like a second-class citizen, feeling passed over for job opportunities with having bonlyq an ADN. Some students spoke of having secured positions that required a BSN but without the educational preparation needing to work harder to overcome the learning curve associated with the position. BEGINNINGS: EDUCATIONAL LIMBO RN BSN students described a period of educational limbo, characterizing the beginnings of their baccalaureate educational journey. For most students, this was an extended period and involved a pattern of stops and starts in pursuing degree requirements. Several students had been working on degree requirements before or shortly after completing their ADN, with one student admitting, bi have been at it for 27 years!q Students long, circuitous, and often frustrating journeys to a BSN resulted from unexpected barriers that emerged along the way. Program requirements that were changeable and inflexible presented major barriers and prevented students from making a steady progress toward the degree. One student captures the programmatic barriers in the following statement: This is my 3rd RN/BSN program. I started out at [another state school] then went to [a state college]. [The college] was way too expensive and [the university school] is not user friendly for nursing working shifts. They also frequently changed their requirements so that it seemed I would never finish. Juggling multiple roles was yet another factor that presented a barrier to moving on with the baccalaureate degree and kept students in limbo. One student describes the limbo she experienced as a result of family responsibilities: I first started working towards my BSN degree in 1981 when my oldest child was just a baby. Job and family responsibilities made it difficult to complete. I remember the day that my daughter tore a page out of my physiology lab notebook. I took a long break from school after that. Although not pervasively, some students experienced obstacles to pursuing their baccalaureate educational track as a result of unsupportive nurse managers or supervisors. Against this backdrop of barriers they had encountered along the way, students expressed concern that something might happen before attaining the degree as reflected in this student comment: I often wonder what will happen to me before August to keep me from finishing. Every time I have pursued my educational opportunities, something has happened to me to prevent it. DISCOVERING DISTANCE EDUCATION: THE TURNING POINT Discovering the RN BSN Distance Track at the study university was a turning point in the RN BSN students educational journey. Finding the distance program moved students from their many years of educational limbo to a serious pursuit of their degree. According to one web student, bi took elective classes off and on over the years, but didn t get serious until I discovered this program.q Students reiterated the bblessingq the distance education program had been, without which it would not have been possible for them to pursue and complete what for many of them was a lifelong goal and dream. In the words of one student, bi can t say enough about how pleased I am with this program.q There was overwhelming agreement among students that the distance education program was the sole reason they were able to obtain the degree. RN BSN students resounded positively about their education program and credited much of it to the design of the program and the support and availability of instructors. Discovering a Doable Design The design of the distance delivery program was critical to RN BSN students continuing pursuit of the baccalaureate degree. bnot easy, but doableq is the slogan that best captures students descriptions of the program. The distance program, whether ETV or
6 288 web based, provided a design that gave students a sense of control and allowed them to continue their professional and personal lives. For students in the ETV modality, having one class day per week allowed them to continue working and going to school full time. One ETV student commented, bit is so different than sitting in a regular classroom. I would rather take every class this way.q Similarly, web students could work at their own pace, according to their hours, and bnot waste time.q Rather than fitting their schedule around courses, the scheduling of course work was fitted to their schedule. Defending the Rigor of the Distance Education Program It was important that program design be user friendly but also rigorous. Students defended the rigor of their distance education program insisting that the quality is comparable with that of an on-site education program, even at times likening the ETV program and the phone bridge to a traditional classroom. Students spoke of having to dispel misconceptions held by some that bdistance learning and internet classes are a breeze.q According to one student: The quality of education that we are getting from ETV is great. I have attended other 4-year institutions on campus and the workload is not easily distinguishable. We are held accountable for the same types of activities that our campus-bound comrades are held. For all students, the course work was demanding and took time away from family, but most perceived these sacrifices as worthwhile to obtain the reward of a degree at the end. BECOMING PROFESSIONAL: MORE THAN JUST A DEGREE Consistent with balready being professionals,q RN BSN students had vaguely defined expectations of changes that might occur as a result of obtaining their RN BSN degree. Initially, most students were interested solely in the educational aspects of the program, advancing their careers, and improving their knowledge base. Unexpectedly, students experienced bbecomingq professionals during the course of their baccalaureate education, which they described as bprofessionalism still in the making,qbprofessionalism has developed,q and bprofessionalism...evolved.q According to one ETV student: My feelings regarding professionalism have certainly evolved. I saw myself as a professional as an associate degree RN. I continued to learn and RUSH ET AL experience different types of nursing. I considered the fact of my education and responsibilities to dmaket me a professional. My thoughts were that nurses are highly respected and make such critical decisions everyday, we must be professionals whatever our education level. However, now after completing the leadership class, concepts and professional issues class...learning about the research process and completing the other courses have increased my knowledge base, so now my opinion is that the baccalaureate nurse is truly the professional nurse. One student who gained awareness of the limitations of not having a BSN while in the program captures the value of the journey, bi felt the degree is what I needed more than the journey to get the degree.q Students were surprised to find that their bnursing education has given me so much more than just a degree.q Students described both generic changes and more specific changes in themselves as professionals. Adding To, Filling In, and Amplifying Professional Behaviors Students described generic changes in terms of existing professional behaviors being added to, filled in, and/or amplified. During the journey to the degree, students experienced an awareness of enhanced knowledge as making them more professional. Students consistently admitted expanding their repertoire of assessment skills, an unexpected surprise for students who perceived these skills to be strong prior to returning to school. Students described deficits in themselves as professionals that were being filled in by their RN BSN distance education experience. Although several students asserted that the RN BSN program had not changed them in terms of their everyday practice, students observed subtle and insidious changes as a result of their distance education experience. According to one student, bnot having my BSN limited my knowledge of nursing practice. I felt I had adequate knowledge to perform my RN roles, realizing now there are many more potential areas of study.q Unexpectedly, RN BSN students found themselves evolving as professionals along many specific dimensions including increased confidence, seeing the big picture, correction of role misconceptions, redirection of professional goals, and renewed excitement for learning. Time management and attention to details were also areas of RN BSN professional growth. Increased Confidence A prevailing area of professional evolution described by students was gaining confidence. Students
7 THE RN BSN DISTANCE EDUCATION EXPERIENCE 289 described having gained confidence in a number of areas related to their practice: asking questions, offering ideas and suggestions, interacting with patients and other health care professionals, acting more assertively, and anticipating clients needs. Key to this increased confidence was a growing body of knowledge. According to one ETV student, bknowledge is definitely empowering.q Gaining knowledge had diminished feelings of intimidation and threat that often accompanied interactions with doctors and engendered a sense of equality. Confidence was also enhanced in decision making, collaborating, and interacting with patients and doctors. Synthesizing or Seeing the Big Picture Seeing the big picture was a significant area of professional growth for RN BSN students. Students described this as being able to put the pieces together to see a person as a whole and the impact of the illness on the person. One student captures the big picture frame of reference with the following comment: bi understand that nursing is about caring for the entire individual, not just the illness.q In addition, students spoke about how their educational experience was synthesizing or helping former experiences make more sense. For example, one student, a nurse manager, applied management principles from her leadership course to practice situations she had encountered and obtained a retrospective understanding of the situations. New Directions One of the unexpected changes for RN BSN students as a result of their educational experience was a redefinition of or redirection in their original professional goals. Students who had not given thought to a management position were now considering it as a possible professional goal. Others expressed a possible redirection in the pursuit of advanced education. Of significance was the desire to pursue graduate work online. Students credited the online program and its structure for making them want to continue their educational journey, one which they had not previously considered. Beverly, I remember when you and I started together, we said this was it. No more education when this is done. Now here we both are considering MSN if it is offered online. Now that we have just about achieved this goal we must have another mountain to climb. I really think that is a credit to this program. If I had to slog through an on-campus program, as I tried to in the past, I wouldn t have gotten this far. Renewed Excitement for Learning There was for some a professional renewal. One student who had expressed being in a professional rut and unstimulated and comfortable in her profession before school experienced motivation, satisfaction, and a renewed excitement for learning. I also have developed a sense of pride at work pride in knowing I m growing and learning. I feel I m dout of the boxt now and am more excited about learning. I find myself wanting to learn even more. I find myself wanting to do poster presentations on everything I learn because I find it so informative...the biggest change I noticed in myself since starting the program is my willingness to learn...the nursing program has shown me that a nurse is never going to be finished learning. The fact that I passed the boards and have a license to practice nursing is not the end of my learning experience, quiet the opposite, it is just the beginning. SHARING THE DISCOVERY OF DISTANCE EDUCATION Discovering the distance education program was so monumental a milestone that RN BSN students were compelled to make their discovery known. This resulted in students journey toward the degree spilling over into their workplace. RN BSN students promoted the distance program with co-workers primarily in four ways: encouraging co-workers to continue education, sharing learning with co-workers, sharing information about the program, and exuding a love and excitement for learning. Students were so successful in their recruitment efforts that bsome people who were only considering another university as their school of choice are now considering this university.q Students shared learning with co-workers by practicing skills on them, involving them in studying class content, and bringing increased knowledge to the work environment. Students shared information about the program by fielding questions from co-workers, giving contact information, and even helping co-workers select prerequisites. As students shared their excitement for the program and their new knowledge, co-workers not only offered support but developed a contagious pursuit of a BSN. Although co-workers observed changes in their colleagues resulting from the stress of balancing multiple roles, generally, they gained interest and excitement in pursuing the degree themselves.